Elise Psychological Services, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC009380 Issued in GA

Legal business name

ELISE PSYCHOLOGICAL SERVICES, LLC

Practice address

1330 Concord Rd SE
Suite 203
Smyrna, GA 30080-4375

Phone

(770) 434-4448

Fax

(770) 434-4449

NPI assigned

Aug 12, 2009

Last updated

Aug 12, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Regina Ward, EDD

Title

Owner

Phone

(770) 434-4448

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Elise Psychological Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Elise Psychological Services, LLC

  • Professional Counselor
  • Lithonia, GA
  • NPI 1669898987
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250035200000",
    "number": "1164654976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4222 CHESTNUT LAKE AVE",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300384568",
            "telephone_number": "770-434-4448",
            "fax_number": "770-424-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 CONCORD RD SE",
            "address_2": "SUITE 203",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300804375",
            "telephone_number": "770-434-4448",
            "fax_number": "770-434-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELISE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-12",
        "last_updated": "2009-08-12",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-434-4448",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC009380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861554776",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.